Good Faith Estimate

You have been referred to my office for treatment and I want to make sure you are “in the know.” I'm required to give you a Good Faith Estimate of the cost of treatment if I am seeing clients using "fee for service.” Since I have not yet evaluated your difficulties or symptoms, must at this point estimate your course of treatment based upon an annual estimate. The number of total sessions that are required to meet your goals are unknown at this time and the duration of our work together can be longer or shorter depending upon your symptoms, your work between sessions, and your response to treatment.

Unless required by a court order (an extremely rare situation), you are free to discontinue treatment at any time, and free to discuss any other modifications to treatment modalities, frequency, or duration. You are ultimately in control of your own healthcare; I am just here to provide help at your request.

At $150.00 per session, the estimated total cost for weekly sessions for a calendar year would he a total cost of $7.800. This initial estimate is valid for 12 months, but you are entitled to receive an update on this estimate at any time upon request.

Additional Forms


  • I will send paperwork to your email to complete before our first session, via SimplePractice.

  • If you need another copy of any of the forms, feel free to email me at kacey@therapywithkacey.com